Dr. Al Puerini – Submitted photo

We came across Trouble No More in a story by Bobby Forand published recently in Motif. He wrote of musicians: “When their creations go out into the world, they open themselves up to being loved, criticized, or ignored (usually all simultaneously), which can lead to an added sense of insecurity. Regardless of professional level, the pressure can take its toll and create or add to mental health issues.” Did the pandemic exacerbate these challenges?

Yes, the pandemic played a significant part in increasing mental health issues throughout the USA. Musicians, in particular were one of the hardest hit groups. As an industry that was already quite difficult to succeed in, the pandemic caused cancellations of almost all live shows – their lifeblood to earn money. Lockdowns, masks, large group cancellations, although completely necessary, added to their solitude.

They couldn’t go out, nightclubs were closed, music gigs were non-existent.  These all created a feeling of isolation, insecurity and loneliness.  Couple this with decreased income and it created a situation ripe for depression and anxiety.

Enter Trouble No More. Can you give us an overview?

Trouble No More was born out of an idea from our co-chair, Don Culp. Tune In & Tune Up has been very active for the past 11 years.  We dealt mainly with medical issues – helping folks navigate the healthcare system, picking the right insurance, how to pick an insurance carrier. We also would help those with no insurance find willing physicians to help them.  We would pay for much or all of the costs.  We gave away over $15,000 in Stop & Shop gift cards to qualifying musicians.

But with the pandemic we could see the rise of mental health issues in our country and specifically in the music industry.  With this knowledge, Don sat for an interview with the local paper, Motif.  In it he admitted to his own occasional dealings with depression and also pointed out our realization that our musical colleagues were especially prone to issues like depression, anxiety and occasionally suicidal ideation.

With that knowledge we all put our heads together and decided a fundraiser with top notch local bands and musicians would be a great venue to raise money to help our local musician friends.

Thanks to support from the Rhode Island Music Hall of Fame, The Ocean Mist and many sponsors and supporters, we were able to put on a first class event at The Ocean Mist and raised a significant amount of money.  All profits will go to assisting musicians and related staff with their medical and mental health issues.

Trouble No More is open not only to performers and creators, but also stagehands and lighting and sound technicians, all part of the music industry, correct? Can you please expand?

We felt that we needed to expand our support to not only musicians  but to those that support the music industry.  Stage hands, sound engineers, lighting crews all experience the same stresses – physical, mental and financial – as our musicians.  Therefore, we felt they should be included in our support.  

What specifically do you offer people via Trouble No More?

We offer them an avenue to easily contact a mental health provider.  Once contact is made, we pay for the first 3 visits.  After that the mental health provider will either continue care at a greatly reduced rate or make a referral to an appropriate provider.  We will continue to support them financially as much as we can.

 And how would someone get in touch?

Email RIMUSICMH@gmail.com

 It’s all confidential, correct?

We are extremely aware of the strict confidentiality of mental health care.  Issues discussed will only be between the client and the provider.  Any notes will only be in the possession of the provider.  Any sharing of information will be done only with the permission of the client.

What was the genesis of the initiative? And who are Mike Petrarca and Kate Nouveau, who were involved.

Mike and Kate are two licensed mental health providers. They did not know each other. We did not contact them.  They both read the article in Motif and immediately contacted us expressing their keen interest in getting involved in what they recognized as a very worthwhile and needed initiative. I always told my patients that mental health providers are a very unique group.  They have devoted their entire professional lives simply to help others in their time of need.

Tell us about your own background.

I have been a family physician for 40 years. I retired from private practice in 2017. I was also President and CEO of Rhode Island Primary Care Physician Corp. for 25 years, retiring in 2019.  We are the largest group of PCPs in R.I.  Our goal is to assist physicians in streamlining their office procedures and helping them provide better, high quality medical care.  We have transformed the payment system by paying physicians for the quality of medical care they provide, not for the amount of people they see.  As a result, our doctors have less administrative duties and can focus more on good patient care. The higher quality care they provide, as measured by many accepted national guidelines, the more money they earn.  We are very proud of this system.

I also am currently the Head Team Physician for Providence College Athletics.  I have had this role for 35 years. Performing sports medicine has been one of the most satisfying parts of my professional career.

I am married to Betsey MacDonald for the past 28 years, have three children and three grandchildren.

 Finally, the Motif piece quoted you: “Our healthcare system is difficult to negotiate. We work hard to make that task easier for the musician who may not have any idea how to approach this crazy system.” I’ve covered healthcare for years, first while I was a staff writer at The Providence Journal and now with Ocean State Stories, and I absolutely agree the system can be difficult to negotiate. Can you expand a bit on that, and not just regarding mental health?

Ask anyone and they will tell you they do not understand our healthcare system and have a very hard time functioning within it. Co-pays, prior authorizations, specialty referrals, out of network care, drug formularies, drug co-pays, hospital bills responsibilities and many more issues make the system impossible to fully understand without an advocate. Our hope is that we, at TITU, can be that advocate and that our musician colleagues understand that they can use us to help them understand and negotiate the system.  This has already happened on several occasions within Tune In Tune Up.

 In an ideal world, what would the solution be?

My personal opinion is that the only way to solve the many problems in healthcare is to institute universal healthcare for all. Although not perfect, it has proven to work in many other industrialized countries. Healthcare should be a right for all not just for those with jobs or money.  Of course, this will probably never happen in the U.S. due to the huge influence of special intertest groups and huge corporations.